Difficult asthma

Garcia, Gilles; and, Macgregor A. Montaño; Humbert, Marc

doi:10.1034/j.1398-9995.2003.02171.x

Cited by 26 publications

(18 citation statements)

References 83 publications

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“…Prevalensi GERD pada asma berkisar 34-80 %. [48][49][50][51] Refluks bisa disebabkan relaksasi sementara sfingter gastroesofagus akibat terapi bronkodilator, pendataran diafragma akibat air trapping dan peningkatan tekanan intraabdominal. 51 GERD dapat menyebabkan eksaserbasi dan meningkatkan gejala asma.…”

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Kepatuhan Berobat pada Pasien Asma Tidak Terkontrol dan Faktor-Faktor yang Berhubungan

Ferliani¹,

Sundaru²,

Koesnoe³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Mencapai kontrol asma masih merupakan tujuan yang sulit dicapai sebagian besar pasien meskipun telah tersedia pedoman manajemen asma internasional dan terapi yang terbukti efektif. Tingkat kontrol asma yang rendah diantaranya disebabkan kepatuhan terhadap pengobatan yang rendah. Hingga saat ini faktor-faktor yang berhubungan dengan kepatuhan berobat pasien asma tidak terkontrol masih sedikit diteliti. Penelitian ini bertujuan mengetahui profil kepatuhan berobat pada pasien asma tidak terkontrol dan hubungan antara faktor terkait pasien, faktor terkait penyakit, faktor terkait pengobatan, faktor terkait sosial ekonomi dan faktor terkait sistem pelayanan kesehatan terhadap kepatuhan berobat pasien asma tidak terkontrol Metode. Penelitian potong lintang terhadap pasien asma tidak terkontrol yang datang ke poliklinik alergi dan imunologi RSCM dari bulan Februari 2012 hingga Mei 2012. Semua pasien asma yang memenuhi kriteria dilakukan anamnesis, pemeriksaan fisis lengkap, pengisian kuesioner, tes kontrol asma, tes Beck Depression Inventory dan Asthma General Knowledge Questionnaire. Analisis awal hubungan kepatuhan dengan faktor-faktor yang diteliti menggunakan uji Chisquare. Kemudian dilanjutkan dengan regresi logistik untuk setiap variabel yang bermakna.Hasil. Dari 125 pasien asma tidak terkontrol didapatkan kepatuhan rendah sebesar 56 %. Dilakukan analisis bivariat terhadap faktor-faktor yang berhubungan dengan kepatuhan yaitu usia, pendidikan, pengetahuan asma, penghasilan, depresi, sediaan obat yang digunakan, keyakinan pasien terhadap dokter, asuransi kesehatan dan hubungan keluarga dan didapatkan pengetahuan bermakna dengan p=0,001 (IK 1,789). Kemudian dilakukan regresi logistik didapatkan pengetahuan paling berpengaruh terhadap kepatuhan (p=0,003) dengan OR 6,933 (IK 1,789) Simpulan. Kepatuhan berobat pada pasien asma tidak terkontrol masih rendah dengan pengetahuan merupakan faktor yang berhubungan dengan kepatuhan. Kata kunci. asma, kepatuhan PENDAHULUANAsma merupakan penyakit peradangan kronis pada saluran napas yang diderita lebih dari 300 juta orang didunia.1,2 Secara umum, prevalensi asma cenderung meningkat dari tahun ke tahun baik di negara maju maupun berkembang.2-4 Berdasarkan data di Amerika pada tahun 2009, 1 dari 12 orang (sekitar 25 juta,atau 8% dari populasi) menderita asma. Angka ini merupakan peningkatan dari prevalensi tahun 2001 yaitu 1 dari 14 (sekitar 20 juta, atau 7%). 4Di Indonesia secara nasional prevalensi asma juga meningkat dari 4,2 % tahun 1995 menjadi 5,4 % tahun 2001. Kota Jakarta sendiri memiliki prevalensi gejala asma yang cukup besar yaitu 7,5 % pada tahun 2005. Masalahnya bukan sekedar kenaikan prevalensi semata, tetapi yang tidak kalah penting adalah dampak dari asma itu sendiri. 5Tujuan pengobatan asma adalah untuk mencapai dan mempertahankan kontrol klinis.2-6 Mencapai kontrol asma masih merupakan tujuan yang sulit dicapai oleh sebagian besar pasien. Kenyataan ini terus terjadi meskipun telah tersedianya pedoman manajemen asma internasional selama le...

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unclassified

Kepatuhan Berobat pada Pasien Asma Tidak Terkontrol dan Faktor-Faktor yang Berhubungan

Ferliani¹,

Sundaru²,

Koesnoe³

et al. 2017

JPDI

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“…In human asthma cases, GER appears to be associated with airway inflammation and has been recognized as an important causative factor in asthma attacks [21,23]. However, the mechanism by which GER may provoke airway inflammation is doubtful.…”

Section: Discussionmentioning

confidence: 99%

Histological Examination of the Relationship between Respiratory Disorders and Repetitive Microaspiration Using a Rat Gastro-Duodenal Contents Reflux Model

et al. 2011

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Microaspiration due to gastroesophageal reflux (GER) has been suggested as a factor contributing to the development and exacerbation of several respiratory disorders. To explore the relationship between GER and respiratory disorders, we histologically examined the bilateral lungs of a rat gastroduodenal contents reflux model, which was previously used to investigate the histogenesis of Barrett's esophagus and esophageal carcinoma. GER was surgically induced in male Wistar rats. The bilateral lungs of the reflux rats were examined with hematoxylin and eosin (HE), PAS-Alcian blue, and Azan staining at 10 and 20 weeks after surgery. Immunohistochemical staining of CD68 and α-SMA was also performed. Aspiration pneumonia with severe peribronchiolar neutrophilic and lymphocytic infiltrates, goblet cell hyperplasia, prominence of blood vessels, and increased thickness of the smooth muscle layer were detected. Bronchiolitis obliterans (BO)-like lesions comprising granulation tissue with macrophages, spindle cells, and multinucleated giant cells in the lumen of respiratory bronchioles were observed in the bilateral lungs of the reflux animals. These findings suggest that the severe inflammation and the BO-like lesions may play a role in exacerbation of the forced expiratory volume in 1 second (FEV 1) in human cases. In conclusion, we speculate that repetitive microaspiration due to GER may contribute to the exacerbation of various respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD), and the development of BO syndrome following lung transplantation. The reflux model is a good tool for examining the causal relationships between GER and respiratory disorders.

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“…(7) Inflammation and airway remodeling result in structural alterations, which seem to explain the permanent reduction in airway diameter. (8)(9)(10) These alterations clinically manifest as fixed airway obstruction. In the present study, this phenotype was not related to greater difficulty in control.…”

Section: Resultsmentioning

confidence: 99%

“…(13) Atopic asthma is the clinical phenotype most often described in the literature, is more common in childhood and is less associated with severe asthma. (10) The frequency of atopy is higher among patients with asthma and rhinitis. Our study identified a clinical phenotype comprising nonsmoking patients with severe asthma, rhinitis, greater functional response to bronchodilator use, more frequent association with aspirin intolerance, better pulmonary function and better final control.…”

Section: Discussionmentioning

confidence: 99%

Fenótipos clínicos de asma grave

2008

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Objective: To characterize clinical phenotypes of severe asthma. Methods: A total of 111 patients were retrospectively evaluated at a specialized outpatient clinic. A systematic protocol for patient evaluation and follow-up was applied. Treatment compliance and control of the disease at the end of follow-up were defined by clinical and functional data. Patients who did not meet asthma control criteria after six months despite compliance with treatment and correct use of medication were characterized as treatment-resistant. Phenotypes were determined by factorial analysis and compared using various tests. Results: At the end of follow-up, 88 patients were considered treatment compliant and 23 were considered noncompliant. Factorial analysis of the compliant patients identified four phenotypes: phenotype 1 (28 patients) comprised patients who were treatment-resistant, more often presenting nocturnal symptoms and exacerbations, as well as more often using rescue bronchodilators; phenotype 2 (48 patients) comprised patients with persistent airflow limitation, lower ratios of forced expiratory volume in one second/forced vital capacity at baseline, more advanced age and longer duration of symptoms; phenotype 3 (42 patients) comprised patients with allergic rhinosinusitis who were nonsmokers and presented predominantly reversible airflow obstruction; and phenotype 4 (15 patients) comprised cases with a history of aspirin intolerance to acetylsalicylic acid associated with near-fatal asthma. Conclusions: A significant number of patients with severe asthma are noncompliant with treatment. Although many patients with severe asthma have persistent airflow obstruction, the most relevant clinical phenotype comprises patients who are resistant to the typical treatment.Keywords: Asthma; Asthma/prevention & control; Asthma/treatment. ResumoObjetivo: Estabelecer os fenótipos clínicos em portadores de asma grave. Métodos: Foram estudados, retrospectivamente, 111 pacientes em um ambulatório especializado. Os pacientes foram avaliados e acompanhados de maneira sistemática, estabelecendo-se ao final do acompanhamento a adesão e o controle ou não da doença por dados clínicos e funcionais. A resistência ao tratamento foi definida como o não preenchimento, ao final do acompanhamento, por pelo menos seis meses, dos critérios de controle de asma, apesar do uso correto e adesão à medicação. Os fenótipos foram determinados por análise fatorial e comparados por testes diversos. Resultados: Ao final, 88 pacientes foram considerados aderentes e 23 não aderentes. Por análise fatorial do grupo aderente, quatro fenótipos foram determinados: o fenótipo 1 (28 pacientes), formado pelos pacientes resistentes ao tratamento, com maior freqüência de sintomas noturnos, maior número de exacerbações e uso mais freqüente de broncodilatador de resgate; o fenótipo 2 (48 pacientes), formado pelos pacientes com obstrução persistente, com menores valores de relação volume expiratório forçado no primeiro segundo/capacidade vital forçada na avaliação ini...

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Difficult asthma

Cited by 26 publications

References 83 publications

Kepatuhan Berobat pada Pasien Asma Tidak Terkontrol dan Faktor-Faktor yang Berhubungan

Kepatuhan Berobat pada Pasien Asma Tidak Terkontrol dan Faktor-Faktor yang Berhubungan

Histological Examination of the Relationship between Respiratory Disorders and Repetitive Microaspiration Using a Rat Gastro-Duodenal Contents Reflux Model

Fenótipos clínicos de asma grave

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